Individual provider Active NPI

Kenyatta Cowains, FNP-C

  • Family Nurse Practitioner
  • Olive Branch, MS
National Provider Identifier
1770199523
Registry record updated Sep 17, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
COWA-NINHNZ Issued in MS
Practice address
9400 Goodman Rd Apt 3704
Olive Branch, MS 38654-1979
Phone
(662) 820-5769
NPI assigned
Sep 17, 2020
Last updated
Sep 17, 2020By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 17, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X COWA-NINHNZ MS Primary

Addresses

Primary practice location

9400 Goodman Rd Apt 3704
Olive Branch, MS 38654-1979

Mailing address

9400 Goodman Rd Apt 3704
Olive Branch, MS 38654-1979
Phone (662) 820-5769

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN, MS2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20250329000040 TN Practitioner - Nurse Practitioner 3971026055 Reassigns benefits to 1 organization
I20250523001857 MS Practitioner - Nurse Practitioner 3971026055 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Fast Pace Mississippi PLLCGroup PAC ID 3678832029, 192 clinicians
Ms Pain and MigraineGroup PAC ID 5496162026, 6 clinicians

Practice addresses (Care Compare)

1195 Church Rd W
Southaven, MS 38671-7144
Phone (662) 253-1067

4 Willow PT
Hattiesburg, MS 39402-1150
Phone (601) 582-6069

50 Veterans Memorial Dr
Kosciusko, MS 39090-3424
Phone (662) 307-2884

517 City Ave S
Ripley, MS 38663-2517
Phone (662) 587-8206

619 S State St
Clarksdale, MS 38614-6319
Phone (662) 966-1012

6244 Hwy 305 N
Olive Branch, MS 38654
Phone (662) 782-5024

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
COWA-NINHNZMSMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Upperline Healthcare, PC CurrentSince Sep 1, 2025 Accepting new patients
Fast Pace Mississippi, PLLC Family CurrentSince May 1, 2025 Accepting new patients
Upperline Healthcare, PC CurrentSince Sep 1, 2025 Accepting new patients
Total Extended Care Services PC CurrentSince Mar 1, 2025 Accepting new patients
Fast Pace Mississippi, PLLC CurrentSince May 1, 2025 Accepting new patients

Locations

18312 Middlebelt Rd
Livonia, MI 48152
Phone (248) 426-9944

7 Professional Pkwy
Ste 101
Hattiesburg, MS 39402
Phone (601) 781-1661

517 City Ave S
Ripley, MS 38663
Phone (662) 587-8206

616 W Forest Ave
Jackson, TN 38301
Phone (731) 422-0330

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1600300800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1600300800000",
    "number": "1770199523",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9400 GOODMAN RD APT 3704",
            "city": "OLIVE BRANCH",
            "state": "MS",
            "postal_code": "386541979",
            "telephone_number": "662-820-5769"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9400 GOODMAN RD APT 3704",
            "city": "OLIVE BRANCH",
            "state": "MS",
            "postal_code": "386541979",
            "telephone_number": "662-820-5769"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COWAINS",
        "first_name": "KENYATTA",
        "credential": "FNP-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-09-17",
        "last_updated": "2020-09-17",
        "certification_date": "2020-09-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MS",
            "license": "COWA-NINHNZ",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Olive Branch, MS

Sources for this page

Verify at the official NPI Registry.